Moments of Terror

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I am sure that most SRNAs and all CRNAs know that anesthesia is usually 99% relaxation and 1% sheer terror. Where I work it is 80% relaxation and 20% sheer terror because we do primarily cardiac anesthesia. It would be great if the CRNAs and SRNAs can share some of their moments of terror in the OR. I will start by discussing my case from Yesterday. We induce a pt for an AVR repair. Pt has a hx of Afib, EF30%, +3 MR. We use a high dose narcotic technique and pavulon as MR. Pt goes into a rapid AFib 180s, B/P tolerating this for the moment. I suggest brevibloc to my attending, he decides on 150 of amiodarone. He gives it and next minute we are still in a rapid AFIB with a MAP of 38. Now seemed like a beautiful time to do a DL. I had the ETT tube in within seconds. B/P is tolerable but we are still in a rapid Afib. Again I suggest brevibloc he goes for the Digoxin. Digoxin is good but we are trying to break the arrythmia now and not 30-40 mins down the road. Finally he gives in and gives the brevibloc and low and behold within seconds we are in an Afib in the one teens. We were playing the little game of because you suggested it I will do something different. I like the guy as we get on great but he is notorious for playing these little games whereas with the other attendings it is not even an issue as they go with whoever has the best idea.

Specializes in CRNA, Finally retired.
I am sure that most SRNAs and all CRNAs know that anesthesia is usually 99% relaxation and 1% sheer terror. Where I work it is 80% relaxation and 20% sheer terror because we do primarily cardiac anesthesia. It would be great if the CRNAs and SRNAs can share some of their moments of terror in the OR. I will start by discussing my case from Yesterday. We induce a pt for an AVR repair. Pt has a hx of Afib, EF30%, +3 MR. We use a high dose narcotic technique and pavulon as MR. Pt goes into a rapid AFib 180s, B/P tolerating this for the moment. I suggest brevibloc to my attending, he decides on 150 of amiodarone. He gives it and next minute we are still in a rapid AFIB with a MAP of 38. Now seemed like a beautiful time to do a DL. I had the ETT tube in within seconds. B/P is tolerable but we are still in a rapid Afib. Again I suggest brevibloc he goes for the Digoxin. Digoxin is good but we are trying to break the arrythmia now and not 30-40 mins down the road. Finally he gives in and gives the brevibloc and low and behold within seconds we are in an Afib in the one teens. We were playing the little game of because you suggested it I will do something different. I like the guy as we get on great but he is notorious for playing these little games whereas with the other attendings it is not even an issue as they go with whoever has the best idea.

Pavulon? Duh? Maybe your attending will remember now that Pavulon will certainly not lower a heart rate. Bad choice for this patient.

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Subee:

Why is pavulon a bad choice for a pt with a MR or AVR? The pt did not come in with a rapid afib. He developed it after induction. Pavulon is a good choice for MR or AVR because of its vagolytic properties. Remember fast, full, forward for AVR and MR. It may not be the best choice for Aortic stenosis or IHSS.

Yoga:

I think I prefer my moments of terror compared to yours. I would probably go into cardiac arrest myself if the generators failed in the OR. It is amazing what people will do for vanity. Does not matter if there is no electricity in the OR as long as I end up with big boobs that is all that counts! All joking aside for thse of us who ( like me) rely on our monitors there is much to learn from CRNAs such as Yoga. The sugery could have continued as a TIVA even without the battery operated pumps. How many SRNAs turn to look at the ETCO2 monitor as soon as you put the ETT in? I know I use to do this. Now i simply look at the humidification in the ETT and the chest going up and down and know that the ETT is in the right place before looking for ETCO2 not saying that you did not need to check for ETCO2. The point is that as time goes by you rely more on your assessment skills rather than monitors.

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Yoga,

Great job with a difficult situation. I'm impressed you had a manual B/P cuff. I don't think we have any left in our hospital except those in PACU which are stuck to the walls.

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Yoga,

Great job with a difficult situation. I'm impressed you had a manual B/P cuff. I don't think we have any left in our hospital except those in PACU which are stuck to the walls.

I keep a manual cuff in the crash cart. There are many times I use the manual cuff when there appears to be a problem with the automatic machine. It works just fine and gives you a chance to monitor the patient while troubleshooting the automatic machine.

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